Patent Application
20200353128
The present invention relates to the field of surgical implants, in particular those used as bone substitutes.
The occurrence of infections during surgical procedures, such as, in particular, the placement of implants, is one of the major concerns of the medical community.
The implants currently used in surgery are of various types: titanium, stainless steel, polyethylene, hydroxyapatite-based ceramic or others.
The conditions for the development of bacteria on the surface of the implants may be linked, in part, to the presence of nutrients under the influence of temperature, humidity, pH of the medium, as well as to the nature of the support. The surfaces of surgical implants may represent ideal substrates for bacterial colonization. The resulting infections are notorious for being difficult to treat, as well as the adhesion of bacteria, and the formation of biofilm that weakens the sensitivity to antibiotics.
Bacterial biofilms are structured clusters of bacterial cells coated with a polymer matrix and attached to a surface. Biofilm protects the bacteria and enables their survival in hostile environmental conditions. Biofilm bacteria can resist the host's immune response and are generally very resistant to antibiotics. Several microorganisms, such as Staphylococcus aureus or Pseudomonas aeruginosa, have this capacity to form a biofilm. The presence of biofilms during infections therefore calls for new methods of prevention and treatment.
The phase of the bacteria anchoring on the implant surface seems to be the most critical step in the development of peri-prosthetic infections.
In order to reduce this bacterial adhesion, it is known to chemically modify the metal surfaces of surgical implants. Thus, Antoci et al. (V. Antoci Jr. et al. Biomaterials 29 (2008) 4684-4690) and Kruszewski et al. (K. M. Kruszewski et al. Materials Science and Engineering C33 (2013) 2059-2069) respectively functionalized TA6V titanium and 316L stainless steel implants with vancomycin by performing a long multi-step synthesis.
Thus, Antoci describes a synthesis with the following steps: passivation (H2O2/H2SO4), aminopropylation with aminopropyl-triethoxysilane, coupling with 2 Fmoc-AEEA spacers, then coupling with vancomycin. Kruszewski describes a synthesis with the following steps: treatment with octadecylphosphonic acid, then with octacosanoic acid, with triethylene glycol with a phosphonic acid ending, then with pentaethylene glycol with a phosphonic acid ending, with 16-phosphonohexadecanoic acid, then coupling with vancomycin or gentamycin. This synthesis results in the formation of multilayers on the surface of the implant that immobilize the antibiotic; these layers are sometimes called SAM for Self-Assembled Monolayers.
There are also metallic nanoparticles coated with silica functionalized with vancomycin as described in Kell et al. (A. J. Kell et al. Chem. Commun., 2007, 1227-1229). In this publication, the silica coatings are treated to provide them with an amino or carboxylate ending, which may then bind to the carboxylic acid or amine function of the vancosamine function of vancomycin.
Mesoporous silica nanoparticles also functionalized with vancomycin have also been described by Qi et al. (ACS Appl. Mater. Interfaces, Publication Date (Web): 16 Oct. 2013). The mesoporous silica nanoparticles are functionalized by adding APS, then vancomycin in admixture with NHS and EDC.
These nanoparticles are clearly not suitable for use as an implant.
Also known are acrylic cements (PMMA type) releasing vancomycin. These are currently used by surgeons as a spacer for a short period of time, but have the disadvantage of having to be removed from the patient's body to make way for an implant. However, there is no coupling and thus no long-term protection.
Finally, Palchesko et al. (Materials Science and Engineering C31 (2011) 637-642) describes a method for coupling vancomycin on a calcium aluminum oxide support (calcium aluminate).
There is a need to further decrease the capacity for biofilm formation on the surface of an alumina ceramic implant.
The invention relates firstly to a porous alumina ceramic matrix grafted with an antibiotic.
According to one embodiment, the porosity of the matrix is between 40 and 80%, preferably between 60 and 70%, advantageously about 65%.
According to one embodiment, the size of the pores is from 100 to 900 μm, preferably from 200 to 600 μm, more preferably about 400 μm.
According to one embodiment, the ceramic matrix has a volume porosity of 45 to 75%, a pore size of 100 to 900 μm, wherein the ceramic is obtained by impregnating a foam, pre-sintering at a temperature above 1200° C., superimpregnation with a slip, and sintering at a temperature above 1500° C., for example above 1600° C.
According to one embodiment, the antibiotic is chosen from among:
According to another aspect of the invention, the matrix according to the invention decreases and/or prevents bacterial proliferation and/or the formation of bacterial biofilm.
According to another aspect of the invention, the matrix is used in therapy or prophylaxis, in particular in the treatment of bone infections, bone cancers, in particular bone metastases.
According to one embodiment, the matrix is used in therapy as blocks of bone fillings, blocks of corpectomy, cages or intervertebral wedges of the cervical or lumbar spine, cervical wedges, calcaneus wedges, osteotomy wedges such as additional tibial wedges, derotation wedges such for anterior tibial tuberosity, compensation, valgization, reconstruction and filling blocks, pins, wedges and pivots for fixation and arthrodesis, drill bit pellets, arthrodesis blocks ensuring maintenance of the natural space or intersomatic interline, special reconstruction implants: sinus filling block, orbit floor and ceiling, craniotomy plugs, filling implants and maxillofacial rehab plates, and any anatomical part on which it is possible to reinsert “nerves” or “facia lata” tissues.
According to another aspect of the invention, the matrix is a prosthesis or an implant.
The subject of the invention is also a method for preparing a matrix according to the invention, comprising the following steps:
According to one embodiment, the ester is an N-hydroxysuccinimide ester, preferably formed in the presence of 1-ethyl-3-(3dimethylaminopropyl)carbodiimide.
The present invention overcomes the disadvantages of the prior art. More particularly, it provides a simple and effective means for reducing bacterial proliferation on the surface of an alumina ceramic.
This is accomplished through a method of coupling an antibiotic to an alumina ceramic matrix.
The invention is now described in more detail and in a non-limiting manner in the description below.
The matrix used in the present invention is a porous ceramic based on alumina Al2O3.
The (open) porosity of this ceramic may, in particular, be between 40 and 80%, preferably between 60 and 70%, advantageously about 65%
The pore size is typically from 100 to 900 μm, preferably from 200 to 600 μm, more preferably about 400 μm.
The porosity/pore size is measured by mercury porosimetry. The porosity is defined by the difference between the volume occupied by the pores and the total volume, wherein the total volume is the sum of the volume of the pores and of the alumina. The weight of alumina is defined by the volume and the density, wherein, by weighing the sample and knowing its total volume, one can determine by difference the volume of pores and therefore the (open) porosity.
The size of the ceramic matrix is variable and may range from a few millimeters to several centimeters or even tens of centimeters; the volume may be between 1 and 250 cm3, for example between 5 and 100 cm3.
The mechanical resistance to compression is advantageously between 20 and 60 MPa, advantageously greater than 40 MPa.
Any known method for the preparation of porous alumina may generally be used. One may, in particular, use a method comprising the following steps:
The method described in patent application FR2823674 may advantageously be used.
The antibiotic to be grafted is an antibiotic having an accessible amine functional group and having an action on the bacterial wall. Antibiotics having an action on the wall on the bacteria are preferred to those having an action inside the bacteria.
Antibiotics may be chosen from the following non-exhaustive list:
The preferred antibiotic is vancomycin and its derivatives.
According to the present invention, the antibiotic is present on the surface of the ceramic matrix, wherein the surface may be the internal surface of the alumina ceramic. The antibiotic is grafted via covalent bonds.
The grafting method makes it possible to link the antibiotic via spacers with an amine functional group on the surface of the alumina ceramic.
The first step involves contacting a diacid in an appropriate solvent. The solvent may be tetrahydrofuran (THF). The diacid may be an aliphatic diacid comprising, apart from the acid functions, from 4 to 14 carbon atoms, for example 8, and may be 1,10-decanedicarboxylic acid. The excess solvent is removed by thorough evaporation. This first step results in the grafting of the spacers on the surface using two hydroxyl groups present on the surface.
The second step is the formation of an N-hydroxysuccinimide (NHS) ester. The acid-modified ceramic is placed in a solution of N-hydroxysuccinimide (NHS) with 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (EDC), in a buffer, for example, of 2-(N-morpholino)ethanesulfonic (MES) acid, for example at room temperature for a time between 10 minutes and 2 hours. The EDC/NHS combination is known for the binding of biomolecules. An NHS ester is obtained at the end of this second step.
The third step is the coupling of the antibiotic. An accessible amine function, based on the application of the principles of steric hindrance, will then react with the NHS ester to form an amide bond, by transamidation. The reaction solvent may be the MES buffer or an organic solvent such as ethanol. The reaction temperature may be, for example, at room temperature. The reaction time may be, for example, between 1 and 48 hours. The pellets are then washed, for example using the same solvent, then cleaned and dried in the conventional manner.
In the case of vancomycin, the reactive site is the glucose-related vancosamine function. This reactive part is identified in
The invention finds application in a large number of uses, in particular in traumatology for reconstructions of fractures, in orthopedics as filling elements, or as implants (for fusion of the spine, etc.), for osteotomies through addition, and for reconstructions, (for example maxillofacial) and, in particular, for interventions in the context of treatment of bone cancers, of a primary or secondary nature.
The invention allows the production of numerous bone substitutes and implants, which may be used, for example, as addition wedges or for bone filling throughout the entire skeleton.
Exemplary applications may be cited such as bone filling blocks, corpectomy blocks, cages or intersomatic wedges of the cervical or lumbar spine, cervical wedges, calcaneus wedges, osteotomy wedges (e.g. tibial addition wedges), derotation wedges (e.g. anterior tibial tuberosity), compensation, valgization, reconstruction and filling blocks, fixing and arthrodesis wedges and pivots, drill bit pellets, arthrodesis blocks ensuring maintenance of the natural space or intersomatic interline, special reconstruction implants: sinus filling block, orbit floor and ceiling, craniotomy plugs, bone filling implants whatever the location of the skeleton, and generally any anatomically-shaped part on which it is possible to reinsert “nerves” or “facia lata” tissues wherever the location of implantation on the skeleton.
The grafting of the antibiotic such as vancomycin on the ceramic reduces the risk of colonization of the material by germs sensitive to vancomycin. The grafted vancomycin interacts with the D-ala-D-ala produced by the bacteria and prevents bacterial transpeptidases (penicillin-binding protein) from forming the peptidoglycan. Therefore, the bacteria cannot form its wall and is lysed.
A particular interest of the invention is long-term protection of the implant to avoid colonization (i) during implantation but, also, (ii) over time given the covalent grafting of the molecule.
The following example illustrates the invention without limiting it.
Step 1:
Alumina ceramic pellets were placed in a solution of 1,10-decanedicarboxylic acid in dry THF (tetrahydrofuran) at room temperature. The excess solvent was removed by placing in the oven.
This first step results in the grafting of the spacers on the surface using two hydroxyl groups present on this surface.
Step 2:
The pellets modified by 1,10-decanedicarboxylic acid were then placed in a solution of 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC)/N-hydroxysuccinimide (NHS) in a 2-(N-morpholino)ethanesulfonic (MES) acid buffer at room temperature to obtain an NHS ester.
Step 3:
Finally, the vancomycin was allowed to react with the pellets from the previous step in the MES buffer. The pellets were then washed with MES buffer and cleaned in an ultrasonic bath.
| Number | Date | Country | Kind |
|---|---|---|---|
| 1761317 | Nov 2017 | FR | national |
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/FR2018/053018 | 11/28/2018 | WO | 00 |
